Cameo Oxford, UK International IJD Blackwell 0011-9059 42 Publishing Journal Ltd, Ltd. of Dermatology 2003
Contact sensitivity to aluminum Contact Akyol CAMEO et sensitivity al. to aluminum
A. Akyol, MD, Prof., A. Boyvat MD, Assoc. Prof., and N. Kundakçi, MD, Prof.
From the Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey Correspondence Aynur Akyol, MD Ankara University Faculty of Medicine Department of Dermatology ˆbni Sina Hospital Samanpazar& Ankara 06100 Turkey E-mail:
[email protected]
Introduction
Discussion
Sensitization to aluminum is extremely rare. Most of the cases have been detected following hyposensitization therapies or vaccinations with substances containing aluminum.1–8 Aluminum allergy is more common in pediatric patients and is rarely reported in adults.3,9 We present a patient in whom aluminum sensitivity was an accidental finding on patch testing, as the patient had a positive reaction at all the test sites.
Sensitization to aluminum is very rare despite its wide distribution in cosmetics and its extensive use in several industries. Aluminum is used as an adjuvant in most commonly used hyposensitization extracts, as aluminum prolongs the period of adsorption and increases the immunologic response.6 Several studies have been published in the literature in which sensitization to aluminum has been caused by repeated injections of substances containing aluminum given over a prolonged period in the course of hyposensitization therapy.1–8 Children with aluminum sensitivity have been reported to develop persistent subcutaneous nodules at the sites of injections or excoriated papules at the sites of hyposensitization therapy. Although aluminum injected as hydroxide in an adsorbed vaccine and antigen extracts can cause granulomas, the small number of reports of aluminum allergy from the aluminum industry indicates that epicutaneous application of aluminum is not strongly sensitizing.10–12 A few cases with axillary eczema as a result of continuous local application of antiperspirants containing aluminum chloride1,13 and a case with otitis externa secondary to the use of aluminum acetate ear drops over a long period have been reported.14 On the other hand Finn Chambers composed of metallic aluminum do not seem to sensitize. This may be because of the fact that intact metal disks are used and also on account of the brief application period. In our patient there was no personal history of atopy or hyposensitization therapy, and aluminum sensitivity is attributed to exposure to aluminum-absorbed vaccines even though
Case Report
942
A 9-year-old boy admitted to our dermatology clinic in April 2002. He had had pruritic erythematous papules on his upper extremities about two years ago. Patch testing performed at that time had revealed positive reactions to numerous allergens. The lesions had cleared within one month, but the family was very much concerned because of the great number of positive patch-test reactions. There was no personal or family history of atopy. The patient had received his routine childhood vaccinations without any adverse effects. The patient was patch-tested again with the European standart series using Finn Chambers on Scanpor tape. Readings at 48 and 96 h revealed positive reactions mostly as a ringed eruption at all the test sites (Fig. 1). A single Finn Chamber was applied alone on Scanpor tape. A positive reaction as an infiltrated ring of papules at the area of most intense contact with the rim of the aluminum Finn Chambers at 48 and 96 h indicated contact allergy to aluminum (Fig. 2). International Journal of Dermatology 2004, 43, 942– 943
© 2004 The International Society of Dermatology
Akyol et al.
Cameo
Figure 2 Patch test with an empty Finn Chamber revealed
annular papules at the area of most intense contact with the rim of the aluminum Finn Chamber
Figure 1 Patch test with the European standard series using Finn
Chambers revealed positive reactions at all the test sites
the patient had received his childhood vaccinations without any adverse effects. Our case demonstrates that aluminum sensitivity may cause misinterpretation of patch test results performed by aluminum Finn Chambers. Contact allergy to aluminum should be considered in patients with positive patchtest reactions typically in the form of ringed eruptions at all of test sites.15,16
References 1 Clemmensen O, Knudsen HE. Contact sensitivity to aluminium in a patient hyposensitized with aluminium precipitated grass pollen. Contact Dermatitis 1980; 6: 305 – 308. 2 Frost L, Johansen P, Pedersen S, et al. Persistent subcutaneous nodules in children hyposensitized with aluminium-containing allergen extracts. Allergy 1985; 40: 368 – 372.
© 2004 The International Society of Dermatology
3 Veien NK, Hattel T, Justesen O, Norholm A. Aluminium allergy. Contact Dermatitis 1986; 15: 295 – 297. 4 Castelain PY, Castelain M, Vervloet D, et al. Sensitization to aluminium by aluminium-precipitated dust and pollen extracts. Contact Dermatitis 1988; 19: 58 – 60. 5 Kaaber K, Nielsen AO, Veien NK. Vaccination granulomas and aluminium allergy. Course and prognostic factors. Contact Dermatitis 1992; 26: 304 – 306. 6 Lopez S, Pelaez A, Navarro LA, et al. Aluminium allergy in patients hyposensitized with aluminium-precipitated antigen extracts. Contact Dermatitis 1994; 31: 37 – 40. 7 Bordet AL, Michenet P, Cohen C, et al. Postvaccination granuloma due to aluminium hydroxide. Ann Pathol 2001; 21: 149 – 152. 8 Cosnes A, Flechet ML, Revuz J. Inflammatory nodular reactions after hepatitis B vaccination due to aluminium sensitization. Contact Dermatitis 1990; 23: 65 – 67. 9 Dwyer CM, Kerr RE. Contact allergy to aluminium in 2 brothers. Contact Dermatitis 1993; 29: 36 –38. 10 Hall AF. Occupational contact dermatitis among aircraft workers. JAMA 1944; 125: 180 – 185. 11 Peters T, Hani N, Kirshberg K, et al. Occupational contact sensitivity to aluminum in a machine construction plant worker. Contact Dermatitis 1998; 39: 322 – 323. 12 Fischer AA. Reactions to aluminium and its salts. Cutis 1984; 33: 154 – 159. 13 Fischer T, Rystedt I. A case of contact sensitivity to aluminium. Contact Dermatitis 1982; 8: 343. 14 O’Driscoll JB, Beck MB, Kesseler ME, et al. Contact sensitivity to aluminium acetate ear drops. Contact Dermatitis 1991; 24: 156 – 157. 15 Bajaj AK, Gupta SC, Pandey RK, et al. Aluminium contact sensitivity. Contact Dermatitis 1997; 37: 307 – 308. 16 Tosti A, Vincenzi C, Peluso AM. Accidental diagnosis of aluminum sensitivity with Finn Chambers. Contact Dermatitis 1990; 23: 48 – 49.
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